禁止反竞争医院合同的影响

研究
禁止反竞争医院合同的影响
白宫
2026 年 6 月 18 日
禁止医院反转向、反分层和全有或全无合同的影响 下载
执行摘要
反引导、反分级和全有或全无的捆绑承包是占主导地位的医院系统避免价格竞争的机制：反引导禁止保险公司将患者引导至低成本的医疗服务提供者；反分级是反引导的一种形式，禁止保险公司将主导系统置于不太有利的福利等级；全有或全无的合同要求保险公司接受系统中的所有医院和附属医生，或者根本不接受。美国司法部 2026 年 2 月对 OhioHealth 的投诉和 2026 年 3 月对纽约长老会医院的投诉均声称反转向限制具有反竞争性。两起案件均悬而未决。
本备忘录对全国范围内禁止所有这三种机制后的医院价格和健康保险保费削减进行了估计。我们估计，禁令将通过三个渠道在直接受影响的市场中将医院和附属医生的价格降低 18%（合理范围为 11% 至 26%），平均每位住院患者约 4,100 美元：恢复保险公司的议价能力、将患者分拣到成本较低的医疗服务提供者，以及随着时间的推移，由于取消这些条款，竞争系统将成为比保险公司更可靠的替代方案，因此会带来额外的价格优惠。按医院和附属医生在雇主资助保险 (ESI) 总支出中的份额（约 57%）进行调整并应用 70% 的转嫁率后，直接受影响市场的 ESI 保费预计将下降 6.5%（从 4% 到 9%）。
在直接受影响的市场中，保费减少相当于每个家庭每年节省约 1800 美元（1,100 美元至 2,500 美元），每个个人每年节省约 600 美元（380 美元至 860 美元）（2025 年美元）。由于 ESI 保费的经济负担落在工人身上，因此这些储蓄通过较低的自付费用保费成本和较高的实得工资的某种组合流向雇员。医院价格的降低还增加了非医疗保健雇主的工资和就业，并增加了联邦所得税收入，其中收益主要集中在中低收入工人身上。我们估计，ESI 覆盖的 24% 的美国人所在的市场中这些条款具有约束力和后果。根据我们的估计，全国 ESI 保费节省了 1.6%，每年约为 450 亿美元（29 至 630 亿美元）。
预期效果因市场结构而异。在具有主导体系和竞争性保险公司的市场中，我们预计保费将减少 4% 至 6%。如果医院系统和保险公司都拥有市场力量，则估计减少 2% 至 3%。在竞争更激烈的市场中，条款普及率较低，为 1% 到 2%。
对于农村社区，多市场系统可能会使用反转向和全有或全无合同，将城市市场力量扩展到农村医院，从而提高这些社区的价格。禁令可以降低农村工人和雇主的保费，提高独立乡村医院的谈判地位，并最大限度地减少系统拥有的乡村医院的压力。

Research
Effects of Banning Anti-Competitive Hospital Contracts
The White House
June 18, 2026
Effects of Banning Hospitals’ Anti-Steering, Anti-Tiering, and All-or-Nothing Contracts Download
Executive Summary
Anti-steering, anti-tiering, and all-or-nothing bundled contracting are mechanisms by which dominant hospital systems insulate themselves from price competition: anti-steering prohibits insurers from directing patients toward lower-cost providers; anti-tiering is one form of anti-steering that bars insurers from placing the dominant system in a less favorable benefit tier; and all-or-nothing contracting requires insurers to accept every hospital and affiliated physician in the system or none at all. The DOJ’s February 2026 complaint against OhioHealth and March 2026 complaint against New York-Presbyterian allege that anti-steering restrictions are anticompetitive. Both cases are pending.
This memo develops estimates of the hospital price and health insurance premium reductions that would follow a nationwide ban on all three mechanisms collectively. We estimate that a ban would reduce hospital and affiliated-physician prices by 18 percent (with a plausible range of 11 to 26 percent), averaging ~$4,100 per inpatient admission, in directly affected markets through three channels: restored insurer bargaining leverage, patient sorting to lower-cost providers, and over time, additional price concessions as removing the clauses allows competing systems to become more credible alternatives to insurers. After scaling by the hospital and affiliated-physician share of total employer-sponsored insurance (ESI) spending (approximately 57 percent) and applying a 70 percent pass-through rate, ESI premiums in directly affected markets would fall by an estimated 6.5 percent (ranging from 4 to 9 percent).
In directly affected markets, that premium reduction corresponds to savings of ~$1800 ($1,100 to $2,500) per family annually and ~$600 ($380 to $860) per individual (2025 dollars). Because the economic incidence of ESI premiums falls on workers, these savings flow to employees through some combination of lower out-of-pocket premium costs and higher take-home wages. Reduced hospital prices also raise payroll and employment at non-health-care employers and increase federal income tax receipts, with gains concentrated among lower- and middle-income workers. We estimate that 24 percent of Americans covered by ESI are in markets where these clauses are binding and consequential. Scaling our estimates to account for that indicates that nationwide ESI premium savings of 1.6 percent, amounting to ~$45 billion ($29 to $63 billion) per year.
The expected effects vary by market structure. In markets with a dominant system and competitive insurers, we expect premium reductions of 4 to 6 percent. Where both the hospital system and insurer have market power, the estimated reduction is 2 to 3 percent. In more competitive markets with lower clause prevalence, 1 to 2 percent.
For rural communities, multi-market systems may use anti-steering and all-or-nothing contracts to extend urban market power to rural hospitals, elevating prices in those communities. A ban could reduce premiums for rural workers and employers, improve the negotiating position of independent rural hospitals, and impose minimal pressure on system-owned rural hospitals.